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A Rose?

I would love to leave the TPDN/Dry Needling issue behind. I also believe that if we explore why what we’ve been doing hasn’t been working we’ll end up empowered rather than defeated.

Many colleagues have been referring to this Will Morris article in AT. I hope you’ll bear with more frequent posts over the next few days as we spend some time pondering his points.

A question for the community – is a key factor here the use of an acupuncture needle?

When an MD injects cortisone into a sore spot, is that acupuncture? Is a vaccination acupuncture? What if a syringe is used to draw fluid out of an area – is that acupuncture? Is the injection therapy done by some LAcs acupuncture? What about use of a tuning fork or a laser at a point – is that acupuncture?

What about the use of an empty hypodermic needle to stimulate a sore spot? At what point does the use of a syringe become acupuncture? Or, is the use of the filiform needle the thing that makes a procedure acupuncture?

Thanks for a clear answer. You know a lot on this topic. It’s great to be having this discussion with you.

If I could make a good salary with benefits I would be interested in the job. Unfortunately, around CT there’s no opportunity for something like that. Wouldnt different people who want different job opportunities in the field? Yes, some acupuncturists make BIG bucks. But it’s foolish for acupuncture students to think they will be that practitioner. Maybe schools need to market to students who want salaried jobs? Yes, schools need to tighten up their programs for hospital jobs to be available to L.Ac’s. Maybe the acupuncture needs to be doctorate program to provide jobs?

I’m surprised L.Ac’s aren’t interested in salaried jobs. Since so many of us are having a hard time developing practices, it’s a great option. Even if it’s for a short period of time, I would think a hospital job would provide exposure to a variety of patients and ailments.

Yup, another good point. Would patients/insurance pay for acupuncture in a hospital setting? I don’t know. I’ve noticed that most commentary medicine is not in a hospital.

To me, these are better questions for our field……compared to what is acupuncture/dry needling?

Glad you are enjoying the discussion! I don’t know how much I know — but I know what I don’t know, which is helpful.

There are 4 community clinics in CT, and at least one of them was hiring back in June, so you may want to check it out. Here is a link to POCA if you want to learn more about that group and see what jobs are open. POCA is working towards starting a school with the idea that graduates would work at POCA clinics (or open their own clinics) rather than going out as independent practitioners.

It would be great to do some surveys — how many in the profession are interested in salaried jobs, what salary would they need to consider it, do they want to work full time, etc. What do you consider a good salary? That would help figure out the economics of it.

It seems like hospitals are moving towards hiring technicians for most jobs. Hiring “Doctors” costs too much. Think about what happens in an MD’s office — you see the doctor for ten minutes and most of the care is given by nurses or assistants. Again, economics — they can pay the assistant just a fraction of what the doctor’s time is “worth.”

Hospital bills are huge and I suspect if I were a patient, with no previous exposure to acupuncture, that wouldn’t be the time I would want to try something new. And, if when I was discharged I didn’t know of a practitioner, didn’t have access to one, etc, what are the odds I’d continue treatment to the point of getting real benefits?

I don’t think chiro’s have made it. They are “main stream” but it appears their field is overwhelmed with practitioners. Since the profession is not integrated in hospitals and medical practices, it’s harder to develop a successful business and financial stability. There are so many in town, it makes me wonder if that’s part of the problem? I’ve been thinking is this where we are headed. An acupuncturist on every corner will provide more pressure to take poor paying insurance and/or scrambling for repeat clients.

Just to throw it out there……maybe as a profession we should look to have acupuncture given to all clients in the hospital? Become part of the paid staff? More integration which would provide a stable salary with benefits? Why do we all need to be independent practitioners? Thoughts?

I don’t really know if their field is overwhelmed — I suspect, like acupuncture, there isn’t even geographical distribution. Some areas have loads of practitioners and some are underserved.

With only 30 or 40 acupuncturists in the entire state of West Virginia, for example, there is a lot of room for growth.

I certainly don’t think we all need to be independent practitioners, but I suspect our schools need to start changing the expectations of the students. For example, Kaiser has tried for years to hire acupuncturists in my area. And until recently, they ended up with MD’s who did acupuncture. Not because that is what they wanted, but because LAcs didn’t want to work 40 hours/week, have limits on numbers of treatments they could give to clients, etc. POCA clinics are often looking to hire, and hire people for W2 positions, with benefits. And they have trouble finding LAcs who want to work for them.

I suppose it is worth figuring out what sort of salary and benefits and requirements would be involved working in a hospital setting — how many treatments would a practitioner have to give in a day, for instance, for it to be worthwhile for the hospital, and then find out how many practitioners would really want to work in that setting. (Another consideration is what impact treatment would have if it was one or two treatments over the course of a hospitalization — and how many patients would want one more thing added to their bill?)

Making a generalization here, but I think chiropractors are not any happier in the system. I believe (once again a generalization) that most practitioners want to do acupuncture as an adjunct to their services to provide another billing source. Insurance pays poorly enough that another service to bill can make or brake a business. Any thoughts on this part of the topic?

I suspect Chiros add acupuncture for a range of reasons — some as a billable service, but some, I am sure, because they believe it will help their clients. Some may be in areas where there are no LAcs to provide the service. I don’t get any sense that Chiros are happier in the system, or more successful – the profession doesn’t seem to be growing in leaps and bounds. It is something I’d like to see our profession research a lot more since we seem to look to the Chiropractors as a group that has made it and that we should emulate.

Do you think L.Ac’s in general would like to practice the way California law is set up? As a general practitioner? I’m located in CT and I would love to have the ability to access blood work and testing? It appears that Cal practitioners have more flexibility and networking due to their licensing laws. Any thought on that? They don’t appear to be worried about “dry needling”?

I’m not really sure what the sense of the community would be – probably divided like it is about everything else. It is hard to keep track of the specifics of the law from state to state. I know in FL acupuncturists also can take on a lot of responsibility. And there is not a good way to get a sense of the profession — do people like it or not. If they aren’t worried about dry needling in CA it might be because the acupuncturists have a lot of political power and might have been able to block the PT’s from using the modality. I just don’t know. One concern about expanding scope to some of the g.p duties would be — 1) training — those aren’t subjects taught in most of the schools or covered on the test, so could we be confident of our skills? 2) Legal responsibility — if checking blood work is part of my profession, and I miss something, or I don’t order a test I should have, could I be at fault? Would malpractice rates go up? 3) How would we be received by the rest of the medical establishment. Would they welcome us, fight it? I don’t know the answers to those questions, and I guess I would want those answers, and a whole lot of analysis, before I came to any conclusion.

I believe the Chiropractors have “won” a lot of the battles we are fighting — they can do more, they are in Medicare, they are more likely to be covered by insurance. And from what I can tell they are not, as a profession, happier or more successful. Finding out more about their professional satisfaction could tell us a lot and help us decide where we want to go.

I love your thoughts. To me I use Chinese medicine to treat clients. I’m more focused on a system of diagnosing rather than just sticking needles. Over time I’ve become less concerned about other modalities stealing “acupuncture” and more interested in educating clients in how Chinese medicine views the body.

In the town i work in I have a chiropractor who uses acupuncture to treat clients. Am I concerned, upset or angry? Nope. They don’t treat with TCM. In fact, my practice is completely different with my TCM background. What does make me upset? That we are clumped into one caterogory…..acupuncture.

I agree with you. Lets stop being concerned about the word acupuncture and put momentum into educating other modalities and clients to understand the healing art behind acupuncture.

Once upon a time, when the profession was making arguments for why MD’s needed additional training to do acupuncture, we said that acupuncture was NOT just putting needles in points, but a complete system of diagnosis and treating. I suppose that argument isn’t getting some of our colleagues what they want (control) in this case. I’ll be writing more on this soon.

In general, I’ve come to believe that upset about what other professions are doing is mostly a sign of self-doubt. As long as we are good at what we do and make it accessible to our communities, we’ll be okay. If the PT’s aren’t trained properly and are hurting people, won’t their own boards and the market deal with the problem?

This whole idea “other modalities will hurt people with acupuncture since they don’t have the training” is BS. As long as the practitioner doesn’t aggressively need deeply, the chance of hurting someone is slim.

It’s a petty excuse. Aren’t we better than this? Sometimes I think we (the collective) are like a bunch of little kids…”this is mine”.

Yes, we spent years arguing that acupuncture was safe, now we are arguing the opposite — and also sending the message that we don’t think the other professions are smart enough or caring enough to self regulate. And, at least when it comes to PT’s, if we insisted that they use the term Dry Needling, it would help the public distinguish between modalities in the case that one profession wasn’t practicing safely. From what I can tell we think we insist on the term acupuncture because we think it will allow us to regulate their practice. It isn’t a good strategy.

Again, well said. Why isn’t the profession focusing on the terms TCM or Five Element or Channel theory? Why not focus on the medicine part? That’s where our success in healing people comes from, not the needling part. Of course we could focus on the part of viewing the client as a whole person, rather than a shoulder or a trigger point. I think that’s our strongest point compared to modern medicine. This is why I don’t worry about the chiropractor treating with acupuncture. He’s simply treating muscle spasms, which is only one facet in the use of acupuncture. I was trained in TCM. I am out of school 10 years. In that time – with a ton of continuing education and learning from mentors – my treatments are focused and more successful. That’s something most “dry needling” practitioners can’t do. TCM is the power behind my treatments, not necessarily acupuncture. We should be focusing on the power and the ART of our medicines.

That all said….I am completely surprised there’s not more dialog on your blog. As practitioners are not interested in the discussion? Are we leaving to others to figure it out? Folks where are we????

I think a lot of practitioners have given up. These conversations are so frustrating sometimes. Over the years people have gotten invested in certain positions — often those positions don’t prevail, for some of the reasons we talk about here, and that just feeds the idea that there is no point in getting involved. And so many of us are struggling to just make it. It becomes easier to just ignore it and focus on the more rewarding work of treating people.